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Building a Bridge From Combat to Civilian Life

By Brian Castner August 28, 2013 1:21 pmAugust 28, 2013 1:21 pm

Small things kill in combat. This truism is as old as war itself, but it proved especially correct in Iraq and Afghanistan, where a new pile of dirt or the glint off a wire in the desert sun could be the sole indication that a bomb lay beneath your feet. So at its heart, military training — from the first day of boot camp to the final predeployment war game — has always really been about paying attention to details. The military knows how to turn on hypervigilance. The question is how to turn it off.

We used to have a name for this process: decompression. Soldiers in conflicts two generations ago had unavoidable transition time: a long boat ride across an ocean, perhaps a train to follow. But a flight from Baghdad to Baltimore is now less than 24 hours, and modern soldiers expect a speedy trip home to a waiting family. When they get it, the experience is usually jarring; think of the penultimate scene in “The Hurt Locker,” where an infinite variety of cereal boxes have replaced the depravity of war, and confusion reigns. The military’s previous attempts to soften this blow by building in decompression time often bred resentment (early in the Iraq war, Army brigades on their way home would sit in Kuwait for two weeks and just play sand volleyball) but offered little relief.

So three years ago, the Air Force began a new program at a more desirable location: the Deployment Transition Center at Ramstein Air Base in Germany. Master Sgt. Joshua Gidcumb, the senior Explosive Ordnance Disposal member of the center’s staff, succinctly described its mission. “Instead of a light switch, we provide a dimmer switch,” he said.

Select, highly stressed units returning from Afghanistan take a break for four days in a sleepy corner of this leafy air base. The service members get out of uniforms and into civilian clothes. Someone else carries their bags. They go to the gym and into Kaiserslautern for dinner and a beer or two, to be in a crowd that is foreign and uncomfortable but safe. They talk about their tour with peers like Sergeant Gidcumb. He calls each group a “class” and the sessions he leads “courses,” but the daily curriculum is fluid, 30 minutes to four hours, and driven by the returning airmen themselves. The main topic of discussion is stress, everything from picking up pieces of dead children after a suicide attack to dealing with creditors trying to collect on unpaid bills. There is no attribution, no judgment and, most important to the deployers themselves, no formal counseling or medical records. As long as what they say is not “suicidal, homicidal or illegal,” Sergeant Gidcumb tells no one.

There are practical benefits to this quasi-summer-camp arrangement. The popular stereotype is that soldiers are reluctant to talk about their symptoms of post-traumatic stress disorder because they are too macho or afraid that their brothers-in-arms will stigmatize them. But there are bureaucratic reasons to keep your mouth shut as well: the medical records of many of those in specialized fields (pilots, bomb technicians, special forces, anyone that works with nuclear weapons) are highly scrutinized, and admitting a mental-health problem can be the first step to permanent disqualification. Many who have struggled for years to join an elite unit would rather privately endure post-deployment anxiety than be kicked out.

“I’d like to think we’re getting past that,” Sergeant Gidcumb said of the stigma. But he also acknowledges admits that being a peer, and not a mental health professional, is key to the program. “I’m just Josh the E.O.D. tech,” he said. “I don’t have access to their medical records. There’s no one keeping notes. I think that makes more people open up.” Significantly, there is no mandatory mental health appointment as part of the four days.

The sergeant eschews the title “Counselor,” and the staff members are hesitant to refer to their program as preventive medicine. “What we do here is not therapy,” said Lt. Col. Rob Rossi, the commander of the center and a military police officer by training. Sergeant Gidcumb and his colleagues simply provide coping skills and a “combat bridge.” And the chaplain and trained mental health workers are nearby if needed, though not ubiquitous.

There is a limit to the relaxed standards. “We provide everything that you need and most of the things you want. But this isn’t spring break, so act accordingly,” Sergeant Gidcumb tells every class upon arrival. There is a daily alcohol limit, a curfew and a schedule, so exhausted or not, airmen are not allowed to sleep for four days. There are also (officially) no conjugal visits, not even with spouses, not even if Ramstein is home base and spouses live just a mile away. Colonel Rossi said internal surveys indicated that 80 percent of those who attend the program give it positive marks, but that additional time away from family is the top complaint.

Sergeant Gidcumb has been around the block, and knows the stress that only a few more days away can bring. He has also been a past guest of the center, and was picked for the temporary assignment (he is there in lieu of another trip to Afghanistan) because of his past experience at Walter Reed National Military Medical Center helping families of the wounded. He says other bomb technicians open up to him because they think he “gets it” in a way a counselor with no firsthand combat experience will not. He speaks their language.

The transition center is an example of what the medical community calls a “peer to peer” or “peer support” program, which have long helped smokers quit smoking and helped veterans reintegrate into civilian life. There have been few such formal programs in the active-duty military, though, and the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury only recently released guidance on best practices for such efforts. While the transition center adheres to most of the recommendations in the report, there is concern among medical professionals about such programs in general. Research has shown that peers can experience relapses of their own disorders, that they sometimes blur the roles of patient and caregiver, and that they are not qualified to identify or treat those in need of immediate mental health care.

So how much can a well-intentioned but nonmedical peer fix in four days, immediately after a combat tour, especially when symptoms of post-traumatic stress disorder can appear months or even years later? Sergeant Gidcumb made it clear that expectations should be kept realistic. “We can’t solve every problem,” he said. “We give them ideas so they can solve them on their own.”

According to the Air Force’s own research, the program is working. Colonel Rossi cited a report from the Air Force Medical Support Agency that found that airmen who go through the center have a statistically significant reduction in self-reported PTSD symptoms, alcohol abuse and personal problems. The report has not been published or released for public scrutiny, but the Air Force cited it in Congressional testimony this year, calling the center one of its major suicide-prevention initiatives.

“That’s encouraging,” Colonel Rossi said, “because often times programs like this, they feel good, they look good, sound great, brief great. But how do you know you’re getting the value out of your dollar and are actually helping people?”

That is good news for those lucky enough to go through the center, but it is not available to everyone. An average class is 150 airmen, and only 6,000 total have transitioned through the Ramstein barracks in the last three years. The Air Force has limited the program to those units most affected by direct combat: explosive technicians, truck drivers, security personnel. And while Navy and Marine Corps E.O.D. units have started to use the center, there are no plans to open enrollment much further.

“If I give you world-class service at 150, you’re going to get diminishing returns if I put 500 through,” Sergeant Gidcumb said. “I’d like to think that if you focus on those that really need it, you’ll provide a better product.”

But the need seems to be there. A report by Iraq and Afghanistan Veterans of America indicated that 45 percent of new veterans received a preliminary diagnosis of post-traumatic stress disorder. Among the 2.5 million service members who went to war after the Sept. 11 attacks, the PTSD rate is estimated at 12 percent to 20 percent. It may take many deployment transition centers to address that decompression problem.

Brian Castner, the author of “The Long Walk: A Story of War and the Life That Follows,” served as an explosive ordnance disposal officer in the Air Force from 1999 to 2007, deploying to Iraq to command bomb disposal units in Balad and Kirkuk in 2005 and 2006. He is a writer based in Buffalo. Follow him on Twitter.

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